Primary care physicians reluctant to prescribe prostate cancer prevention drug

A new survey says they don't know that finasteride is used for chemoprevention. Urologists fear the drug could raise the risk of tumors.

By — Posted Sept. 2, 2010

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Physicians have not been quick to prescribe finasteride to men as a way to prevent prostate cancer, according to a new study.

A 2003 New England Journal of Medicine study showed a 25% reduced risk of prostate cancer when the drug was used. But 64% of urologists and 80% of primary care physicians said they never prescribe finasteride for chemoprevention, according to a study in the September issue of Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Assn. for Cancer Research. The study was published online Aug. 10.

When asked why they didn't prescribe finasteride as a preventive tool, 52% of surveyed primary care physicians said they did not know it could be used for chemoprevention. Among urologists, 55% said they were concerned that it would increase the risk for high-grade tumors (link).

An editorial that accompanied the 2003 NEJM study noted a 27% increased risk in high-grade tumors when patients took finasteride as a preventive medication. However, a 2008 report in Cancer Prevention Research said finasteride did not increase the risk of such tumors; it just made the tests available for the tumors more sensitive (link).

The new study showed that 34% of primary care physicians and 66% of urologists believed the benefits of finasteride for prevention outweighed or equaled its risks.

Researchers surveyed 464 primary care physicians and 302 urologists in the Veterans Health Administration. They also evaluated trends among prescriptions for finasteride filled within the VHA between January 2000 and December 2005. Doctors were encouraged to use finasteride for benign prostatic hyperplasia with symptoms not relieved by other drugs.

The data showed that physicians were prescribing finasteride more often, but "the change did not seem to be due to increased use of finasteride for chemoprevention," the study concluded.

Chemoprevention has been studied for other cancers, including breast and colorectal cancers, but physicians have not adopted it widely.

"There will probably be increasing attention to this topic. Right now, physicians don't have good tools to know who is at risk and who might benefit," said internist and preventive medicine specialist Linda S. Kinsinger, MD, MPH, a study author and chief consultant for preventive medicine at the VHA's National Center for Health Promotion and Disease Prevention in North Carolina.

Better tools need to be created to determine which patients would be most likely to benefit from chemoprevention, she said, adding that the medications being used need to be as safe as possible.

"We are asking people who don't have a condition to take a medication. That is a high bar," Dr. Kinsinger said.

Even something as common and inexpensive as aspirin being used as a chemopreventive agent would raise issues about the bleeding it could cause, she said.

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story